Active NPI
Peter Su, MD
- Family Medicine Physician
- Gambrills, MD
National Provider Identifier
1184664146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- D0056977
- Practice address
- 1438 Defense Highway
Suite 201
Gambrills, MD 21054 - Phone
- (410) 721-3200
- Fax
- (410) 721-2680
- NPI assigned
- Jun 7, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | D0056977 | MD | Primary |
Addresses
Primary practice location
1438 Defense Highway
Suite 201
Gambrills, MD 21054
Mailing address
1438 Defense Highway
Suite 201
Gambrills, MD 21054
Phone (410) 721-3200
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 407044800 | Other | MEDICAL ASSISTANCE | |
| 558223 | Other | INFORMED | |
| 1S80P | Other | BLUE CROSS BLUE SHIELD | |
| F1880001 | Other | BCBS FEDERAL | |
| 13564 | Other | JOHNS HOPKINS HLTH CARE | |
| 7120279 | Other | AETNA | |
| F1880001 | Other | CAREFIRST | |
| P15312 | Other | BCBS MPOS | |
| 407048800 | Medicaid | MD | |
| 4301934 | Other | CIGNA | |
| F1880001 | Other | BLUE CHOICE | |
| 165131 | Other | COVENTRY HEALTH | |
| 223342 | Other | MAMSI | |
| 223342 | Other | ALLIANCE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100513000631 | MD | Practitioner - Family Practice | 3577691443 | Practice locations: Gambrills, MD |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0056977 | MD | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553040000000",
"number": "1184664146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1438 DEFENSE HIGHWAY",
"address_2": "SUITE 201",
"city": "GAMBRILLS",
"state": "MD",
"postal_code": "21054",
"telephone_number": "410-721-3200",
"fax_number": "410-721-2680"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1438 DEFENSE HIGHWAY",
"address_2": "SUITE 201",
"city": "GAMBRILLS",
"state": "MD",
"postal_code": "21054",
"telephone_number": "410-721-3200",
"fax_number": "410-721-2680"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SU",
"first_name": "PETER",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-06-07",
"last_updated": "2019-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MD",
"license": "D0056977",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL ASSISTANCE",
"identifier": "407044800",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INFORMED",
"identifier": "558223",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "1S80P",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS FEDERAL",
"identifier": "F1880001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "JOHNS HOPKINS HLTH CARE",
"identifier": "13564",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7120279",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST",
"identifier": "F1880001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS MPOS",
"identifier": "P15312",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "407048800",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "4301934",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CHOICE",
"identifier": "F1880001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COVENTRY HEALTH",
"identifier": "165131",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "223342",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALLIANCE",
"identifier": "223342",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Gambrills, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.